Provider Demographics
NPI:1760455042
Name:DESAI, PARESHKUMAR G (MD)
Entity Type:Individual
Prefix:
First Name:PARESHKUMAR
Middle Name:G
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12109 COUNTY ROAD 103
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-2951
Mailing Address - Country:US
Mailing Address - Phone:352-205-8981
Mailing Address - Fax:352-391-6498
Practice Address - Street 1:3264 W AUDUBON PARK PATH
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-8450
Practice Address - Country:US
Practice Address - Phone:352-628-7671
Practice Address - Fax:352-628-9893
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044157208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL591942276001OtherCHAMPUS
FL340016073OtherMEDICARE RAILROAD
FL048743100Medicaid
FL09071OtherBLUE SHIELD FL
FL340016073OtherMEDICARE RAILROAD
FL591942276001OtherCHAMPUS
FL09071YMedicare PIN